Abstract 4368736: Long-Term Clinical Outcomes in Patients with Heart Failure with Reduced Ejection Fraction and Mitral Regurgitation Undergoing MitraClip Therapy with Comorbid Malnutrition: A U.S. Population Based Cohort Study

Introduction: Growing evidence has highlighted the detrimental impact of malnutrition on outcomes among patients undergoing structural heart interventions. However, there is still a paucity of data on patients with heart failure with reduced ejection fraction (HFrEF) who undergo transcatheter edge-to-edge repair with the MitraClip device for the treatment of mitral regurgitation (MR). Therefore, we aimed to investigate this association using a national-level database. Method: Data from the U.S. Collaborative Network–TriNetX were used to evaluate the impact of malnutrition on patients with HFrEF (defined as LVEF <40%) and MR who underwent MitraClip implantation. Patients were classified into two cohorts: those with malnutrition identified by the relevant ICD-10 code and those without. The malnutrition cohort was propensity score matched to a control group based on age, sex, race, and various comorbidities to ensure balanced comparison. Patients were followed for 3 years after MitraClip implantation to evaluate clinical outcomes, including all-cause mortality, worsening HF, incidence of atrial fibrillation (AF) or atrial flutter (AFL), stroke, pulmonary embolism (PE), and deep vein thrombosis (DVT). Results: After propensity score matching, each cohort included 594 patients with comparable baseline characteristics. The mean age was 72.3 years in the malnutrition group compared to 73.0 years in the non-malnutrition group, with males comprising 53.5% and 52.7% of each group, respectively. Within 3 years post-MitraClip placement, patients with malnutrition had a significantly higher risk of adverse outcomes, including mortality (HR: 1.68, 95% CI: 1.36–2.08, P<0.05), worsening HF (HR: 1.47, 95% CI: 1.30–1.66, P<0.05), AF/AFL (HR: 1.22, 95% CI: 1.06–1.41, P<0.05), stroke (HR: 1.62, 95% CI: 1.09–2.42, P<0.05), PE (HR: 2.03, 95% CI: 1.16–3.54, P<0.05), and DVT (HR: 2.37, 95% CI: 1.19–4.71, P<0.05). Conclusion: Patients with HFrEF and comorbid malnutrition are at increased risk of adverse outcomes following MitraClip placement, including higher rates of mortality, worsening HF, AF/AFL, stroke, PE, and DVT. Addressing nutritional deficiencies prior to MitraClip implantation may be essential for optimizing clinical outcomes and warrants further investigation.